Category: CBT
5 More Steps to Cope with Irritability
Posted by info in CBT, Worry Sunday, 24 October 2010 08:42 No Comments
This is a cross posting from my brain fitness blog. As it turns out, worry is probably bad for your brain fitness, so coping with worry not only can improve your mood but may also help improve your thinking and memory. Here the post:
Irritability means letting small things that happen to all of us everyday set off a train of upsetting thoughts. Last week I posted about the negative effect of obsessions and ruminations on brain fitness – some researchers now call them unconstructive repetitive thoughts, or URT (for that post, click here). I wrote about the process of thinking about things that cause negative emotions.
It’s likely that this kind of thinking is associated with increases in cortisol and immune system markers associated with inflammation. The whole “chemical soup” is neurotoxic. The same chemicals are associated with mental and physical decline in older persons. Younger persons aren’t off the hook, though, because research increasingly shows that cognitive decline starts in early life. As several researchers remarked at the Cognitive Aging Summit two weeks ago, “Aging begins at birth.”
One of the things that sets off URT for many people is a random or casual event or thought. Someone cuts you off on the freeway, or you get stuck in the wrong line at the grocery store, or a co-worker makes a comment that upsets you. It’s at that point that the URT gets going, and it’s at that point that you can do something to stop it.
From the point of view of cognitive therapy, the actual event isn’t so important. It’s the fact that it sets off. or activates, a underlying pattern of thought that some people call a schema.You have a choice: (1) go with the URT, and feel upset, and activate a set of chemical processes that are bad for your brain, or (2) stop by the process and move on (in your mind, or in your life) to something else.
In my previous post, I laid out a three-step plan for dealing with URT. Those steps emphasized being aware of the thoughts, deciding whether thinking about the upsetting event was going to resolve anything, and then making a commitment to dealing with the thoughts.
Here are 5 more steps to deal with irritability and improve your brain fitness:
- Assign yourself homework: Commit to noticing when you engage in URT at least once a day for a week.
- Pay attention to the event that set you off.
- Decide what the event means to you. Did the comment from a coworker set off worries about how good you are at your job? Did the person on the freeway make you feel as though everyone was down on you? Did the line at the grocery make you feel panicky about getting everything you had to do done?
- Come up with a more reasonable response to what you’re thinking. Maybe say something like, “That person probably didn’t mean to upset me,” or “Even if he or she did that to make me feel bad, I get to choose how I react.”
- Repeat each step at least once a day. The way you think is a habit, and the only way to change a habit is to practice doing something different.
Three Ways to Deal with Unconstructive Repetitive Thoughts
Posted by info in CBT, Depression, Treatment, Worry, meditation Thursday, 14 October 2010 21:07 No Comments
Several researchers have shown that negative mood, anxiety, and distress can be associated with cognitive decline. Wilson and his colleague Patricia Boyle (both at Rush in Chicago) have shown with data from the Religious Orders Study that persons who are chronically distressed have a greater chance of cognitive decline.
At the Cognitive Aging Summit (sponsored by the National Institute on Aging and featuring NIA-supported research), Martin Sliwinski reported data that show that the specific aspect of emotional distress that may be linked to problems in thinking and memory is something called unconstructive repetitive thought (URT).
Although the term reeks of jargon, it is helpful because it helps us understand the difference between various types of worry, ruminating, or obsessing. URT means that someone thinks a lot about something that is upsetting, but it doesn’t go anywhere.
It’s a little like pushing at a sore tooth in your mouth – you know that you shouldn’t, and that if you don’t leave it alone, you may make it worse. But still, it’s hard to stop.
It’s easy to guess that repeatedly thinking about upsetting things (your boss or spouse yelling at you, an especially bad ride home on the freeway that involved someone cutting in front of you) might cause repeated releases of stress-related neurohormones and immune factors.
Since we know that many of these substances have the capacity to be neurotoxic, it’s a simple (though unproven) link from URT to cognitive impairment.
How do you deal with URT?
- First, pay attention to thoughts that bother you and are upsetting. You may be engaging in URT without realizing it. Ask yourself, Is thinking about this making my heart race or making me feel jumpy and angry? Notice what you’re thinking about.
- Second, decide whether thinking is going to resolve anything. Sometimes, thinking about something over and over can help you figure out a solution to a problem. But worrying over and over about something in the past or future that you can’t control just makes you miserable. No matter how much you think about something, you can’t change the past or control the future.
- Third, make a commitment to deal with thoughts if you can’t deal with the problem. If you’re want to spend time going over something in your mind over and over, schedule a time (maybe 15 minutes) and do so. Don’t do the thinking any other time. Usually, people who learn to relax through meditation or breathing can learn to stop their URT. Regular mediation practice can also help you stop.
Brain Fitness and The Mind of a Monk
Posted by info in Anxiety, CBT, Treatment, meditation Monday, 11 January 2010 21:20 No Comments
I saw an interesting blog post several days ago on the site of the Huffington Post about the potential benefits of meditation – or at least about what one woman thinks might be the benefits.
Priscilla Warner writes about the contrast between Tibetan monks’ apparent calm, evident even on brain scans, and her own anxiety disorder.
Ms. Warner says that she suffers from panic disorder, a severe form of anxiety in which a person can have multiple anxiety attacks every day, even in the middle of the night. Her post is titled “I Want the Brain of a Monk” Although most people don’t suffer from anxiety this severe, many people have symptoms of anxiety. And research has consistently shown that higher levels of anxiety are related to more memory problems.
What’s the relation to brain fitness? In my brain fitness class, I often mention the usefulness of meditation in helping reduce stress and anxiety, both of which have negative effects on memory. You don’t have to go to Tibet to get the benefits of meditation. If you simply take 10 minutes several times a day to break in to the ongoing rush of getting things done, you’ve made a start. Use those 10 minutes to sit quietly, relax your muscles, and breathe deeply.
If you do that every day for two weeks, I think you’ll notice that you feel calmer and better able to focus. And if you’re better able to focus, you will be better able to pay attention and remember things.
Cognitive Therapy and Post Partum Depression
Posted by info in CBT, Depression, Medications, Treatment Friday, 2 January 2009 07:10 No Comments
A reader recently reported that she is suffering from post partum depression and asked whether cognitive therapy might help her. She wondered whether cognitive therapy might help her get off her current medications.
It’s not possible for us to comment on any specific case in this blog, because it’s beyond the scope of the blog to provide treatment. At least one study has shown that cognitive therapy is helpful in post partum depression (Misri S, Reebye P, Corral M, Milis L. The use of paroxetine and cognitive-behavioral therapy in postpartum depression and anxiety: a randomized controlled trial. J Clin Psychiatry. 2004 Sep;65(9):1236-41), so it may be worth considering this treatment option.
What’s most important is that anyone with post partum depression get treatment! I would suggest that anyone interested in this issue first consult with the person who is prescribing the medication for depression. Don’t stop the medication without the advice of the clinician who is prescribing the medication!
If your clinician doesn’t know any competent cognitive therapists, you can contact the Academy of Cognitive Therapy for a possible referral (Academy of Cognitive Therapy website).
Cognitive-Behavioral Therapy
Posted by info in CBT Thursday, 25 January 2007 07:24 No Comments
Cognitive-behavioral therapy (CBT for short) is one of the best ways to help people who worry too much. CBT is a commonsense approach that helps you to examine your thoughts, feelings, and behaviors and the interplay between each of these elements. As an example, let’s consider what might happen if you are worried about getting a project done. Your thoughts might sound something like this: “What if I don’t get this project done right? What if it’s not exactly what the client wants? What will my client think? I could lose the account and who knows, maybe the company will fire me?
If all of these worrisome thoughts are racing around in your head, it stands to reason that you might feel anxious and fearful. You might even be experiencing physical symptoms like headaches, muscle tension, an upset stomach or you might become irritable or short-tempered.
As a result of your thoughts and feelings, you might avoid talking to your boss or co-workers just in case they ask you how the project is going. You might be so caught up in getting the project done perfectly that you actually procrastinate. In addition, you might think that you need the extra incentive that being on a very tight schedule creates in order to motivate you to produce a great outcome.
Using CBT, you can begin to examine your thoughts and test whether the negative consequences you are envisioning actually happen. You would also go further than these initial thoughts to tease apart the underlying expectations and eventually, understand what the structure of your beliefs are regarding this situation. Going back to the example, getting fired might mean that this person thinks he will become homeless and people ignore him and treat him like he is not worthy of respect. A possible explanation for these worries that the person in our example holdsis a fundamental belief is that he is worthless. His negative emotions and avoidance type of behavior then make sense in light of his beliefs.
Of course, it may not be at all realistic that this person is worthless. With CBT you able put this belief to the test. For example, what experiences in the past have both shaped this belief and have countered it? Are there situations where this person felt worthwhile and respected? Has he ever rebounded from a disappointment and gone on to feel good about himself? Has he ever done something less than perfectly? What was the result?
He might also test out the consequences of not avoiding. If this gentleman took the risk to discuss his project with other people what might happen? We call this method of counteracting avoidance an “exposure.” If as a first stem, we asked him to talk about the project with someone outside of work, what happens? If he then approaches a secretary and mentions what he’s working on is he given the third degree. What about having a conversation over work with a co-worker — do they focus only on his project and then chastise him for not being further along. And finally, what happens if he actually brings up the project status with his boss? Are his worries and fears realized? If actually doing each of these steps is too hard, an alternative is to do an imaginal exposure. In other words, you can imagine each of these steps before doing them. In either case, you keep practicing these situations until your anxiety is less. In addition, you use the information you are gathering during the course of the exposures to help yourself re-evaluate the extent to which you believe the negative thoughts. You will also have much more realistic information that will help you develop a new set of beliefs that will, eventually, allow you to spend less time worrying.